Lower lip reconstruction

The lower lip is important not only in normal daily functions such as eating and speaking, but also in emotional expressions. Given the complexity of the function that lower lip serves, the reconstruction of the lower lip presents a particular challenge.

Normally lower lip reconstruction involves several methods that essentially “borrow” from the adjacent skin and mucosal soft tissue. One major issue with these methods is that the mouth opening becomes smaller as a result. This problem can be particularly prominent if the amount of lower lip loss is significant.

A more complicated reconstruction method involves transplantation of the soft tissue from another part of the body with the accompanying blood vessels to reconstruct and build a new lower lip, also known as the free flap procedure or microvascular free tissue transfer. Forearm soft tissue is an ideal site given its thinness and pliability. The transplanted forearm tissue is folded and contoured to resemble the lower lip. In order to recreate the vermillion border, or the prominent front roll of the lip, a segment of the arm tendon is transplanted as well.

The transplanted forearm tissue requires constant supply of blood and nutrients as in any living tissue of the body. This requires connecting the blood vessels that have been transplanted from the forearm to blood vessels to those in the neck, which is done under microscope with ultra-fine sutures.

This animation illustrates the surgical treatment of an advanced case of oral cancer arising from the lower lip and involving lymph nodes in the neck. The Head and Neck Oncologic surgery team begins with removal of the lip and oral cavity cancer, followed by neck dissections for removal of malignant lymph nodes in the neck. At the same time, a team of Facial Plastic and Reconstructive surgeons harvests an area of the forearm as donor tissue to reconstruct the lower lip and face. This donor tissue is called a free flap. The free flap is released from its native blood supply in the forearm and attached to arteries and veins in the neck. The forearm free flap will supply tissue to recreate the form and function of the oral cavity and lip.

This animation illustrates an advanced case of head and neck cancer as treated by members of the UT-Houston Otorhinolaryngology department. Our specialists in Head and Neck Oncologic Surgery as well as Facial Plastic and Reconstructive Surgery are trained and experienced in the management of complex tumors of the head and neck.